CLINICAL FEATURES

Tremor, rigidity, bradykinesia and postural instability are cardinal features of parkinsonism.

The tremor is generally most pronounced in the hands but may involve the legs, lips, tongue, and neck muscles, and is easily seen in the eyelids when they are lightly closed. Its frequency is 4 to 5 per second or in some patients could be 7 to 8.

Rigidity [an increase in resistance to passive movement] is responsible for the characteristically flexed [stooped] posture seen in patients.

Bradykinesia is the most disabling symptom. Is manifested by slowness of voluntary movements and a reduction in automatic movements such as swinging of the arms while walking.

Staring and immobile facial expression, (MASK FACE) a monotonous voice, a lack of spontaneous movements of postural adjustments are characteristic.

It has often been observed that even severely disabled patients may, when excited or under great emotional stress, perform complex motor acts quickly and efficiently. The severity of the symptoms is considerably influenced by emotional factors, being aggravated by anxiety, tension, and unhappiness, and minimal when the patient is in the contented frame of mind.

Intellectual deterioration is not a consistent feature of early Parkinson’s disease, dementia has been recognized to be a feature of advanced Parkinson’s disease.